Pancreatic Cancer - Important Facts One Needs to Know

What Is Pancreatic Cancer?

Malignant cells that grow in a portion of the pancreas cause pancreatic cancer. The exocrine or endocrine glands' ability to function as well as the pancreas' overall function may be impacted by this. Although the pancreas can develop cancer anywhere in its body, the head of the organ accounts for 70 percent of cases.

Over 95 percent of pancreatic cancer cases are exocrine tumors. Pancreatic duct lining cells are the initial site of the most prevalent kind, called an adenocarcinoma.

Pancreatic neuroendocrine tumors (NETs) make for about 5 percent of all pancreatic malignancies. They begin in the cells that produce hormones.

The Stages of Pancreatic Cancer

AJCC - I (American Joint Committee on Cancer):

• T1N0: Limited to the pancreas, up to 2 cm.

• T2N0: Limited to the pancreas, more than 2 cm.

AJCC - II:

• T3N1: Spread beyond the pancreas, to local lymph nodes.

AJCC - III:

• T4 any N: Spread to the celiac axis and superior mesenteric artery.

AJCC - IV:

• M1: Distant metastasis.

What Are the Types of Pancreatic Cancer?

There are two types of pancreatic cancer.

Exocrine Pancreatic Cancer: The exocrine cells that make up the pancreatic ducts and exocrine glands are the source of exocrine pancreatic cancer. Enzymes secreted by the exocrine gland aid in the digestion of proteins, acids, lipids, and carbohydrates in the duodenum.

• Adenocarcinoma: Over 90 % of cases of pancreatic cancer are of adenocarcinoma, also known as ductal carcinoma. It is the most prevalent kind of the disease. The pancreatic duct lining is affected by this malignancy.

• Squamous Cell Carcinoma: Since squamous cells are not normally seen in the pancreas, this incredibly unusual nonendocrine pancreatic cancer originates in the pancreatic ducts. It is impossible to properly understand the roots of this disease due to the small number of documented instances. Studies have shown that because most cases are found after metastasis, the prognosis is very poor.

• Adenosquamous Carcinoma: Of all exocrine pancreatic tumors, this uncommon kind accounts for 1 % to 4 %. Adenosquamous carcinoma has a worse prognosis and is a more aggressive tumor than adenocarcinoma. These tumors exhibit traits common to both squamous cell carcinoma and ductal adenocarcinoma.

• Colloid Carcinoma: One to three percent of exocrine pancreatic tumors are colloid carcinomas, another uncommon form. Intraductal papillary mucinous neoplasms, a benign cyst type, are typically the source of these tumors (IPMN). Compared to other pancreatic cancers, the pancreatic colloid tumor is more unlikely to spread and is easier to cure since it is made up of malignant cells floating on a gelatinous substance called mucin. Its outlook is likewise far better.

Neuroendocrine Pancreatic Cancer: The endocrine gland of the pancreas secretes insulin and glucagon into the bloodstream to control blood sugar levels. From these cells, pancreatic neuroendocrine tumors (NETs) arise. Neuroendocrine malignancies are extremely uncommon, accounting for less than 5 % of instances of pancreatic cancer. They are sometimes referred to as endocrine or islet cell tumors.

What Are the Causes?

1. Consuming tobacco.

2. Age: Adults over 60 account for the majority of instances.

3. Diabetes mellitus, especially if it has just been discovered.

4. Ovarian, colon, or pancreatic cancer in the family history.

5. Persistent pancreatitis.

6. Overindulgence in alcohol.

7. Being obese.

What Are the Signs and Symptoms?

The clinical features of pancreatic cancer are

• Jaundice.

• Weight loss.

• abdominal discomfort.

• epigastric pain.

• Pruritus.

• Lethargy.

• Backache.

• Nausea.

• Vomiting.

• Diabetes.

• Acute pancreatitis.

The signs of pancreatic cancer are

• Jaundice.

• Scratch marks.

• Cachexia (muscle wastage).

• Courvoisier's sign- palpable gall bladder.

• Metastasis causes hepatomegaly.

• Virchow's nodes.

• Sister Mary Joseph nodules.

How Is Pancreatic Cancer Diagnosed?

Pancreatic cancer can be investigated through

• CT (Computed tomography) scan.

• MRI (Magnetic resonance imaging).

• MRCP (magnetic resonance cholangiopancreatography).

• ERCP (endoscopic retrograde cholangiopancreatography).

• EUS (endoscopic ultrasound scan).

• FDG-PET (Fluorodeoxyglucose).

• EUS guided FNAC (fine needle aspiration cytology).

• ERCP provides ductal brushing or pancreatic juice sampling and serum marker CA19-9.

How Can Pancreatic Cancer Be Treated?

1. In the case of resectable disease, the Whipple procedure is preferred. Pylorus-preserving pancreatic duodenectomy and postoperatively, 5FU (Fluorouracil) with FA (Folinic acid) or Gemcitabine are given.

2. In the case of inoperable and locally advanced disease, Gemcitabine is given. If a response is seen in three to six months, then radiotherapy may be added.

3. For metastatic pancreatic cancer, chemotherapy is used and either one of the following combinations is preferred.

• Gemcitabine.

• Gemcitabine and Erlotinib.

• Gemcitabine and Capecitabine.

• Gemcitabine and Nab-paclitaxel.

• FOLFIRINOX, a combination of 5FU/FA, Irinotecan, and Oxaliplatin.

What Are the Risk Factors for Pancreatic Cancer?

The following variables may increase the risk of pancreatic cancer:

• Smoking.

• Diabetes type 2.

• Pancreatitis is the term for persistent pancreatic inflammation.

• Genetic mutations can raise the risk of cancer running in the family. These include Lynch syndrome, familial atypical multiple mole melanoma (FAMMM) syndrome, and mutations in the BRCA2 gene.

• History of pancreatic cancer in the family.

• Being overweight.

• Older years. Most pancreatic cancer patients are older than 65.

• Excessive alcohol consumption.

What Are the Complications?

1. Reduced Weight: Individuals who have pancreatic cancer may experience weight loss due to the disease's increased energy consumption. Eating may be difficult if cancer therapies are causing nausea and vomiting or if the malignancy is pressing on the stomach. The pancreas sometimes produces insufficient digestive fluids, which causes the body to have difficulties absorbing nutrients from food.

2. Jaundice: The bile duct in the liver might become blocked by pancreatic cancer. Yellowing of the skin and the whites of the eyes are symptoms. Pale stools and black urine are two signs of jaundice. Jaundice frequently happens without abdominal pain.

3. Pain: An expanding tumor may put pressure on the abdomen's nerves, resulting in potentially excruciating pain. Painkillers may make one feel more at ease. Chemotherapy and radiation therapy are two examples of treatments that may help reduce tumor growth and alleviate some pain.

4. Blockage of the Bowel: Pancreatic cancer has the potential to invade or press against the duodenum, the first segment of the small intestine. This may stop food that has been broken down from moving from the stomach into the intestines.

What Is the Prognosis of Pancreatic Cancer?

The size and nature of the tumor, the involvement of lymph nodes, and the extent of metastasis (spread) at the time of diagnosis all affect the long-term prognosis for pancreatic cancer. The prognosis for pancreatic cancer is better the earlier it is identified and treated.

1. Five-Year Survival Rate: The percentage of all patients who are still alive five years after diagnosis is quite low for pancreatic cancer (5 to 10 percent) when compared to many other malignancies. This is because a far higher number of patients receive a stage IV diagnosis after the illness has spread.

2. Prognosis for Stage IV: The five-year survival rate for Stage IV pancreatic cancer is 1 percent. Patients with late-stage pancreatic cancer typically have a one-year survival rate following diagnosis.

3. Potentially Curable If Discovered Extremely Early: Although pancreatic cancer has a generally dismal prognosis and is primarily incurable, it may be curable if discovered extremely early. After receiving therapy, up to 10 percent of patients with an early diagnosis recover completely from their illness. The typical survival duration for patients with pancreatic cancer is 3 to 3.5 years if they are discovered before the tumor grows significantly or spreads.

4. Improved Prognosis for Resectable Tumors: Patients with tumors that can typically be surgically removed (resected) have better life rates overall than those whose tumors are discovered after they have spread or become locally advanced.

Of all pancreatic tumors, 15 to 20 percent are treatable. Tumors in stages I and II are among them. Rarely, locally progressed stage III tumors are described as "borderline," and if the patient has access to a skilled, highly qualified surgeon, they may be removed. Normally, these tumors are deemed unresectable, meaning they do not qualify for surgery.

Conclusion:

The pancreas is a gland in the abdomen that helps in digestion; pancreatic cancer affects this gland. Nausea, bloating, exhaustion, jaundice, and lack of appetite are some of the symptoms of pancreatic cancer. Among the treatments include radiation therapy, chemotherapy, and surgery. The medical professional is available to support one during this challenging period. Patients may choose to join a pancreatic cancer support group in the local area or online. Socializing with like-minded individuals may be uplifting and good for mental and emotional well-being. One can discuss their feelings with a social worker, therapist, or counselor as well. Patients and their family can benefit from a number of useful resources, and remember that knowledge is power.